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Testimony:
Before the Chairman, Committee on Homeland Security, House of
Representatives:
United States Government Accountability Office:
GAO:
For Release on Delivery:
Expected at 2:00 p.m. EST:
Wednesday, July 29, 2009:
Influenza Pandemic:
Gaps in Pandemic Planning and Preparedness Need to Be Addressed:
Statement of Bernice Steinhardt:
Director, Strategic Issues:
GAO-09-909T:
GAO Highlights:
Highlights of GAO-09-909T, a testimony before the Chairman, Committee
on Homeland Security, House of Representatives.
Wht GAO Did This Study:
As the current H1N1 outbreak underscores, an influenza pandemic remains
a real threat to our nation. Over the past 3 years, GAO conducted a
body of work, consisting of 12 reports and 4 testimonies, to help the
nation better prepare for a possible pandemic. In February 2009, GAO
synthesized the results of most of this work and, in June 2009, GAO
issued an additional report on agency accountability for protecting the
federal workforce in the event of a pandemic. GAOís work points out
that while a number of actions have been taken to plan for a pandemic,
including developing a national strategy and implementation plan, many
gaps in pandemic planning and preparedness still remain.
This statement covers six thematic areas: (1) leadership, authority,
and coordination; (2) detecting threats and managing risks; (3)
planning, training, and exercising; (4) capacity to respond and
recover; (5) information sharing and communication; and (6) performance
and accountability.
What GAO Found:
* Leadership roles and responsibilities for an influenza pandemic need
to be clarified, tested, and exercised, and existing coordination
mechanisms, such as critical infrastructure coordinating councils,
could be better utilized to address challenges in coordination between
the federal, state, and local governments and the private sector in
preparing for a pandemic.
* Efforts are underway to improve the surveillance and detection of
pandemic-related threats, but targeting assistance to countries at the
greatest risk has been based on incomplete information, particularly
from developing countries.
* Pandemic planning and exercising has occurred at the federal, state,
and local government levels, but important planning gaps remain at all
levels of government. At the federal level, agency planning to maintain
essential operations and services while protecting their employees in
the event of a pandemic is uneven.
* Further actions are needed to address the capacity to respond to and
recover from an influenza pandemic, which will require additional
capacity in patient treatment space, and the acquisition and
distribution of medical and other critical supplies, such as antivirals
and vaccines.
* Federal agencies have provided considerable guidance and pandemic-
related information to state and local governments, but could augment
their efforts with additional information on school closures, state
border closures, and other topics.
* Performance monitoring and accountability for pandemic preparedness
needs strengthening. For example, the May 2006 National Strategy for
Pandemic Influenza Implementation Plan does not establish priorities
among its 324 action items and does not provide information on the
financial resources needed to implement them. Also, greater agency
accountability is needed to protect federal workers in the event of a
pandemic because there is no mechanism in place to monitor and report
on agenciesí progress in developing workforce pandemic plans.
The current H1N1 pandemic should serve as a powerful reminder that the
threat of a pandemic influenza, which seemed to fade from public
awareness in recent years, never really disappeared. While federal
agencies have taken action on 13 of GAOís 24 recommendations, 11 of the
recommendations that GAO has made over the past 3 years have not been
fully implemented. With the possibility that the H1N1 virus could
become more virulent this fall or winter, the administration and
federal agencies should use this time to turn their attention to
filling in the planning and preparedness gaps GAOís work has pointed
out.
What GAO Recommends:
This statement discusses the status of GAOís prior recommendations on
the nationís planning and preparedness for a pandemic. Key open
recommendations concern the need to exercise the shared federal
leadership roles for a pandemic, address planning gaps at all levels of
government and in the private sector, and monitor and report on
agenciesí plans to protect their workers.
View [hyperlink, http://www.gao.gov/products/GAO-09-909T] or key
components. For more information, contact Bernice Steinhardt at (202)
512-6543 or steinhardtb@gao.gov.
[End of section]
Mr. Chairman and Members of the Committee:
I am pleased to be here today to discuss key themes from the body of
work GAO has developed over the past several years to help the nation
better prepare for, respond to, and recover from a possible influenza
pandemic. An influenza pandemic remains a real threat to our nation and
to the world, as we are witnessing during the current H1N1 pandemic.
The previous administration took a number of actions to plan for a
pandemic, including developing a national strategy and implementation
plan. However, much more needs to be done, and many gaps in planning
and preparedness still remain. Strengthening preparedness for large-
scale public health emergencies, such as an influenza pandemic, is one
of 13 urgent issues that we identified earlier this year as among those
needing the immediate attention of the new administration and Congress.
[Footnote 1]
In the past 3 years, GAO has issued 12 reports and 4 testimonies on
influenza pandemic planning.[Footnote 2] We synthesized the results of
most of our work in a February 2009 report, which I will discuss in
more detail today.[Footnote 3] In addition, I will discuss key results
from our recent report on protecting the federal workforce in the event
of a pandemic.[Footnote 4] We have made 24 recommendations based on the
findings from these reports, 13 of which have been acted upon by the
responsible federal agencies. The responsible federal agencies have
generally agreed with our recommendations and some actions are underway
to address them. However, 11 recommendations have not yet been fully
implemented. While our February 2009 report made no new
recommendations, it reflects the status of those recommendations that
were made prior to our June 2009 report that had not yet been
implemented. Many of the recommendations that remain unimplemented have
become even more pressing in light of the very real possibility of the
return of a more severe form of the H1N1 virus later this year. Lists
of our open recommendations and related GAO products that are
referenced throughout this statement are located in attachments I and
II.
In summary, my statement will address the following issues which were
drawn from the key themes of GAO's pandemic work:
* Leadership roles and responsibilities for an influenza pandemic need
to be clarified, tested, and exercised, and existing coordination
mechanisms, such as critical infrastructure coordinating councils,
could be better utilized to address challenges in coordination between
the federal, state, and local governments and the private sector in
preparing for a pandemic.
* Efforts are underway to improve the surveillance and detection of
pandemic-related threats in humans and animals, but targeting
assistance to countries at the greatest risk has been based on
incomplete information, particularly from developing countries.
* Pandemic planning and exercising have occurred at the federal, state,
and local government levels, but important planning gaps remain at all
levels of government. At the federal level, agency planning to maintain
essential operations and services while protecting their employees in
the event of a pandemic is uneven.
* Further actions are needed to address the capacity to respond to and
recover from an influenza pandemic, which will require additional
capacity in patient treatment space, and the acquisition and
distribution of medical and other critical supplies, such as antivirals
and vaccines.
* Federal agencies have provided considerable guidance and pandemic-
related information to state and local governments, but could augment
their efforts with additional information on school closures, state
border closures, and other topics.
* Performance monitoring and accountability for pandemic preparedness
needs strengthening. For example, the May 2006 National Strategy for
Pandemic Influenza Implementation Plan (National Pandemic
Implementation Plan) does not establish priorities among its 324 action
items and does not provide information on the financial resources
needed to implement them. Also, greater agency accountability is needed
to protect federal workers in the event of a pandemic because there is
no mechanism in place to monitor and report on agencies' progress in
developing workforce pandemic plans that provide the operational
details of how agencies will protect their employees and maintain
essential operations and services.
As noted earlier, this statement is based on our prior work, which was
conducted in accordance with generally accepted government auditing
standards. Those standards require that we plan and perform the audit
to obtain sufficient, appropriate evidence to provide a reasonable
basis for our findings and conclusions based on our audit objectives.
We believe that the evidence obtained provides a reasonable basis for
our findings and conclusions based on our audit objectives.
Background:
Given the consequences of a severe influenza pandemic, in 2006, GAO
developed a strategy for our work that would help support Congress's
decision making and oversight related to pandemic planning. Our
strategy was built on a large body of work spanning two decades,
including reviews of government responses to prior disasters such as
Hurricanes Andrew and Katrina, the devastation caused by the 9/11
terror attacks, efforts to address the Year 2000 (Y2K) computer
challenges, and assessments of public health capacities in the face of
bioterrorism and emerging infectious diseases such as Severe Acute
Respiratory Syndrome (SARS). The strategy was built around six key
themes as shown in figure 1. While all of these themes are
interrelated, our earlier work underscored the importance of
leadership, authority, and coordination, a theme that touches on all
aspects of preparing for, responding to, and recovering from an
influenza pandemic.
Figure 1: Key Themes of GAO's Pandemic Strategy:
[Refer to PDF for image: illustration]
Performance and accountability;
Information sharing and communication;
Leadership, authority, and coordination;
Capacity to respond and recover;
Planning, training, and exercising;
Detecting threats and managing risks.
Source: GAO.
[End of figure]
Influenza pandemic--caused by a novel strain of influenza virus for
which there is little resistance and which therefore is highly
transmissible among humans--continues to be a real and significant
threat facing the United States and the world. Unlike incidents that
are discretely bounded in space or time (e.g., most natural or man-made
disasters), an influenza pandemic is not a singular event, but is
likely to come in waves, each lasting weeks or months, and pass through
communities of all sizes across the nation and the world
simultaneously. However, the current H1N1 pandemic seems to be
relatively mild, although widespread. The history of an influenza
pandemic suggests it could return in a second wave this fall or winter
in a more virulent form.[Footnote 5] While a pandemic will not directly
damage physical infrastructure such as power lines or computer systems,
it threatens the operation of critical systems by potentially removing
the essential personnel needed to operate them from the workplace for
weeks or months. In a severe pandemic, absences attributable to
illnesses, the need to care for ill family members, and fear of
infection may, according to the Centers for Disease Control and
Prevention (CDC), reach a projected 40 percent during the peak weeks of
a community outbreak, with lower rates of absence during the weeks
before and after the peak.[Footnote 6] In addition, an influenza
pandemic could result in 200,000 to 2 million deaths in the United
States, depending on its severity.
The President's Homeland Security Council (HSC) took an active approach
to this potential disaster by, among other things, issuing the National
Strategy for Pandemic Influenza (National Pandemic Strategy) in
November 2005, and the National Pandemic Implementation Plan in May
2006.[Footnote 7] The National Pandemic Strategy is intended to provide
a high-level overview of the approach that the federal government will
take to prepare for and respond to an influenza pandemic. It also
provides expectations for nonfederal entities--including state, local,
and tribal governments; the private sector; international partners; and
individuals--to prepare themselves and their communities. The National
Pandemic Implementation Plan is intended to lay out broad
implementation requirements and responsibilities among the appropriate
federal agencies and clearly define expectations for nonfederal
entities. The Plan contains 324 action items related to these
requirements, responsibilities, and expectations, most of which were to
be completed before or by May 2009. HSC publicly reported on the status
of the action items that were to be completed by 6 months, 1 year, and
2 years in December 2006, July 2007, and October 2008 respectively. HSC
indicated in its October 2008 progress report that 75 percent of the
action items have been completed. We have ongoing work for this
committee assessing the status of implementing this plan which we
expect to report on in the fall of 2009.
Leadership Roles and Responsibilities Need to Be Clarified and Tested,
and Coordination Mechanisms Could Be Better Utilized:
Federal government leadership roles and responsibilities for pandemic
preparedness and response are evolving, and will require further
testing before the relationships among the many federal leadership
positions are well understood. Such clarity in leadership is even more
crucial now, given the change in administration and the associated
transition of senior federal officials. Most of these federal
leadership roles involve shared responsibilities between the Department
of Health and Human Services (HHS) and the Department of Homeland
Security (DHS), and it is not clear how these would work in practice.
According to the National Pandemic Strategy and Plan, the Secretary of
Health and Human Services is to lead the federal medical response to a
pandemic, and the Secretary of Homeland Security will lead the overall
domestic incident management and federal coordination. In addition,
under the Post-Katrina Emergency Management Reform Act of 2006, the
Administrator of the Federal Emergency Management Agency (FEMA) was
designated as the principal domestic emergency management advisor to
the President, the HSC, and the Secretary of Homeland Security, adding
further complexity to the leadership structure in the case of a
pandemic.[Footnote 8] To assist in planning and coordinating efforts to
respond to a pandemic, in December 2006 the Secretary of Homeland
Security predesignated a national Principal Federal Official (PFO) for
influenza pandemic and established five pandemic regions each with a
regional PFO and Federal Coordinating Officers (FCO) for influenza
pandemic. PFOs are responsible for facilitating federal domestic
incident planning and coordination, and FCOs are responsible for
coordinating federal resources support in a presidentially declared
major disaster or emergency.
However, the relationship of these roles to each other as well as with
other leadership roles in a pandemic is unclear. Moreover, as we
testified in July 2007, state and local first responders were still
uncertain about the need for both FCOs and PFOs and how they would work
together in disaster response.[Footnote 9] Accordingly, we recommended
in our August 2007 report on federal leadership roles and the National
Pandemic Strategy that DHS and HHS develop rigorous testing, training,
and exercises for influenza pandemic to ensure that federal leadership
roles and responsibilities for a pandemic are clearly defined and
understood and that leaders are able to effectively execute shared
responsibilities to address emerging challenges.[Footnote 10] In
response to our recommendation, HHS and DHS officials stated in January
2009 that several influenza pandemic exercises had been conducted since
November 2007 that involved both agencies and other federal officials,
but it is unclear whether these exercises rigorously tested federal
leadership roles in a pandemic.
In addition to concerns about clarifying federal roles and
responsibilities for a pandemic and how shared leadership roles would
work in practice, private sector officials told us that they are
unclear about the respective roles and responsibilities of the federal
and state governments during a pandemic emergency. The National
Pandemic Implementation Plan states that in the event of an influenza
pandemic, the distributed nature and sheer burden of the disease across
the nation would mean that the federal government's support to any
particular community is likely to be limited, with the primary response
to a pandemic coming from states and local communities. Further,
federal and private sector representatives we interviewed at the time
of our October 2007 report identified several key challenges they face
in coordinating federal and private sector efforts to protect the
nation's critical infrastructure in the event of an influenza
pandemic.[Footnote 11] One of these was a lack of clarity regarding the
roles and responsibilities of federal and state governments on issues
such as state border closures and influenza pandemic vaccine
distribution.
Coordination Mechanisms:
Mechanisms and networks for collaboration and coordination on pandemic
preparedness between federal and state governments and the private
sector exist, but they could be better utilized. In some instances, the
federal and private sectors are working together through a set of
coordinating councils, including sector-specific and cross-sector
councils. To help protect the nation's critical infrastructure, DHS
created these coordinating councils as the primary means of
coordinating government and private sector efforts for industry sectors
such as energy, food and agriculture, telecommunications,
transportation, and water.[Footnote 12] Our October 2007 report found
that DHS has used these critical infrastructure coordinating councils
primarily to share pandemic information across sectors and government
levels rather than to address many of the challenges identified by
sector representatives, such as clarifying the roles and
responsibilities between federal and state governments.[Footnote 13] We
recommended in the October 2007 report that DHS encourage the councils
to consider and address the range of coordination challenges in a
potential influenza pandemic between the public and private sectors for
critical infrastructure. DHS concurred with our recommendation and DHS
officials informed us at the time of our February 2009 report that the
department was working on initiatives to address it, such as developing
pandemic contingency plan guidance tailored to each of the critical
infrastructure sectors, and holding a series of "webinars" with a
number of the sectors.
Federal executive boards (FEB) bring together federal agency and
community leaders in major metropolitan areas outside of Washington,
D.C., to discuss issues of common interest, including an influenza
pandemic. The Office of Personnel Management (OPM), which provides
direction to the FEBs, and the FEBs have designated emergency
preparedness, security, and safety as an FEB core function. The FEB's
emergency support role with its regional focus may make the boards a
valuable asset in pandemic preparedness and response. As a natural
outgrowth of their general civic activities and through activities such
as hosting emergency preparedness training, some of the boards have
established relationships with, for example, federal, state, and local
governments; emergency management officials; first responders; and
health officials in their communities. In a May 2007 report on the
FEBs' ability to contribute to emergency operations, we found that many
of the selected FEBs included in our review were building capacity for
influenza pandemic response within their member agencies and community
organizations by hosting influenza pandemic training and exercises.
[Footnote 14] We recommended that, since FEBs are well positioned
within local communities to bring together federal agency and community
leaders, the Director of OPM work with FEMA to formally define the
FEBs' role in emergency planning and response. As a result of our
recommendation, FEBs were included in the National Response Framework
(NRF)[Footnote 15] in January 2008 as one of the regional support
structures that have the potential to contribute to development of
situational awareness during an emergency. OPM and FEMA also signed a
memorandum of understanding in August 2008 in which FEBs and FEMA
agreed to work collaboratively in carrying out their respective roles
in the promotion of the national emergency response system.
Efforts Are Underway to Improve the Surveillance and Detection Of
Pandemic-Related Threats, but Targeting Assistance to Countries at the
Greatest Risk Has Been Based on Incomplete Information:
International disease surveillance and detection efforts serve as an
early warning system that could prevent the spread of an influenza
pandemic outbreak. The United States and its international partners are
involved in efforts to improve pandemic surveillance, including
diagnostic capabilities, so that outbreaks can be quickly detected.
Yet, as reported in 2007, international capacity for surveillance has
many weaknesses, particularly in developing countries.[Footnote 16] As
a result, assessments of the risks of the emergence of influenza
pandemic by U.S. agencies and international organizations, which were
used to target assistance to countries at risk, were based on
insufficiently detailed or incomplete information, limiting their value
for comprehensive comparisons of risk levels by country.
Pandemic Planning and Exercising Has Occurred, but Planning Gaps
Remain:
The National Pandemic Strategy and National Pandemic Implementation
Plan are important first steps in guiding national preparedness.
However, important gaps exist that could hinder the ability of key
stakeholders to effectively execute their responsibilities. In our
August 2007 report on the National Pandemic Strategy and Implementation
Plan, we found that while these documents are an important first step
in guiding national preparedness, they do not fully address all six
characteristics of an effective national strategy, as identified in our
work.[Footnote 17] The documents fully address only one of the six
characteristics, by reflecting a clear description and understanding of
problems to be addressed. Further, the National Pandemic Strategy and
Implementation Plan do not address one characteristic at all,
containing no discussion of what it will cost, where resources will be
targeted to achieve the maximum benefits, and how it will balance
benefits, risks, and costs. Moreover, the documents do not provide a
picture of priorities or how adjustments might be made in view of
resource constraints. Although the remaining four characteristics are
partially addressed, important gaps exist that could hinder the ability
of key stakeholders to effectively execute their responsibilities. For
example, state and local jurisdictions that will play crucial roles in
preparing for and responding to a pandemic were not directly involved
in developing the National Pandemic Implementation Plan, even though it
relies on these stakeholders' efforts. Stakeholder involvement during
the planning process is important to ensure that the federal
government's and nonfederal entities' responsibilities are clearly
understood and agreed upon. Further, relationships and priorities among
actions were not clearly described, performance measures were not
always linked to results, and insufficient information was provided
about how the documents are integrated with other response-related
plans, such as the NRF. We recommended that the HSC establish a process
for updating the National Pandemic Implementation Plan and that the
updated plan should address these and other gaps. HSC did not comment
on our recommendation and has not indicated if it plans to implement
it.
Federal Workforce Pandemic Planning:
The National Pandemic Implementation Plan required federal agencies to
develop operational plans for protecting their employees and
maintaining essential operations and services in the event of a
pandemic. In our June 2009 report, we found that federal agency
progress in pandemic planning is uneven.[Footnote 18] We surveyed the
pandemic coordinators from the 24 agencies covered by the Chief
Financial Officers Act of 1990, which we supplemented with a case study
approach of 3 agencies.[Footnote 19] We used the survey to get an
overview of governmentwide pandemic influenza preparedness efforts. The
survey questions asked about pandemic plans; essential functions other
than first response that employees cannot perform remotely; protective
measures, such as procuring pharmaceutical interventions; social
distancing strategies;[Footnote 20] information technology testing; and
communication of human capital pandemic policies. Although all of the
surveyed agencies reported being engaged in planning for pandemic
influenza to some degree, several agencies reported that they were
still in the early stages of developing their pandemic plans and their
measures to protect their workforce. For example, several agencies
responded that they had yet to identify essential functions during a
pandemic that cannot be performed remotely. And, although many of the
agencies' pandemic plans rely on telework to carry out their functions,
5 agencies reported testing their information technology capability to
little or no extent.
The three case study agencies also showed differences in the degree to
which their individual facilities had operational pandemic plans. The
Bureau of Prisons' correctional workers had only recently been required
to develop pandemic plans for their correctional facilities. The
Department of Treasury's Financial Management Service, which has
production staff involved in disbursing federal payments such as Social
Security checks, had pandemic plans for its four regional centers and
had stockpiled personal protective equipment. By contrast, the Federal
Aviation Administration's air traffic control management facilities,
where air traffic controllers work, had not yet developed facility
pandemic plans or incorporated pandemic plans into their all-hazards
contingency plans.
State and Local Pandemic Planning:
We reported in June 2008 that, according to CDC, all 50 states and the
3 localities that received federal pandemic funds have developed
influenza pandemic plans and conducted pandemic exercises in accordance
with federal funding guidance.[Footnote 21] A portion of the $5.62
billion that Congress appropriated in supplemental funding to HHS for
pandemic preparedness in 2006--$600 million--was specifically provided
for state and local planning and exercising. All 10 localities that we
reviewed in depth had also developed plans and conducted exercises, and
had incorporated lessons learned from pandemic exercises into their
planning.[Footnote 22] However, an HHS-led interagency assessment of
states' plans found on average that states had "many major gaps" in
their influenza pandemic plans in 16 of 22 priority areas, such as
school closure policies and community containment, which are community-
level interventions designed to reduce the transmission of a pandemic
virus. The remaining 6 priority areas were rated as having "a few major
gaps." Subsequently, HHS led another interagency assessment of state
influenza pandemic plans and reported in January 2009 that although
they had made important progress, most states still had major gaps in
their pandemic plans.[Footnote 23]
As we had reported in June 2008, HHS, in coordination with DHS and
other federal agencies, had convened a series of regional workshops for
states in five influenza pandemic regions across the country.[Footnote
24] Because these workshops could be a useful model for sharing
information and building relationships, we recommended that HHS and
DHS, in coordination with other federal agencies, convene additional
meetings with states to address the gaps in the states' pandemic plans.
As reported in February 2009, HHS and DHS generally concurred with our
recommendation, but have not yet held these additional meetings.
[Footnote 25] HHS and DHS indicated at the time of our February 2009
report that while no additional meetings had been planned, states will
have to continuously update their pandemic plans and submit them for
review.
We have also reported on the need for more guidance from the federal
government to help states and localities in their planning. In June
2008, we reported that although the federal government has provided a
variety of guidance, officials of the states and localities we reviewed
told us that they would welcome additional guidance from the federal
government in a number of areas, such as community containment, to help
them to better plan and exercise for an influenza pandemic.[Footnote
26] Other state and local officials have identified similar concerns.
According to the National Governors Association's (NGA) September 2008
issue brief on states' pandemic preparedness, states are concerned
about a wide range of school-related issues, including when to close
schools or dismiss students, how to maintain curriculum continuity
during closures, and how to identify the appropriate time at which
classes could resume.[Footnote 27] NGA also reported that states
generally have very little awareness of the status of disease
outbreaks, either in real time or in near real time, to allow them to
know precisely when to recommend a school closure or reopening in a
particular area. NGA reported that states wanted more guidance in the
following areas: (1) workforce policies for the health care, public
safety, and private sectors; (2) schools; (3) situational awareness
such as information on the arrival or departure of a disease in a
particular state, county, or community; (4) public involvement; and (5)
public-private sector engagement.
Private Sector Pandemic Planning:
The private sector has also been planning for an influenza pandemic,
but many challenges remain. To better protect critical infrastructure,
federal agencies and the private sector have worked together across a
number of sectors to plan for a pandemic, including developing general
pandemic preparedness guidance, such as checklists for continuity of
business operations during a pandemic. However, federal and private
sector representatives have acknowledged that sustaining preparedness
and readiness efforts for an influenza pandemic is a major challenge,
primarily because of the uncertainty associated with a pandemic,
limited financial and human resources, and the need to balance pandemic
preparedness with other, more immediate, priorities, such as responding
to outbreaks of foodborne illnesses in the food sector and, now, the
effects of the financial crisis.
In our March 2007 report on preparedness for an influenza pandemic in
one of these critical infrastructure sectors--financial markets--we
found that despite significant progress in preparing markets to
withstand potential disease pandemics, securities and banking
regulators could take additional steps to improve the readiness of the
securities markets.[Footnote 28] The seven organizations that we
reviewed--which included exchanges, clearing organizations, and payment-
system processors--were working on planning and preparation efforts to
reduce the likelihood that a worldwide influenza pandemic would disrupt
their critical operations. However, only one of the seven had completed
a formal plan. To increase the likelihood that the securities markets
will be able to function during a pandemic, we recommended that the
Chairman, Federal Reserve; the Comptroller of the Currency; and the
Chairman, Securities and Exchange Commission (SEC), consider taking
additional actions to ensure that market participants adequately
prepare for a pandemic outbreak. In response to our recommendation, the
Federal Reserve and the Office of the Comptroller of the Currency, in
conjunction with the Federal Financial Institutions Examination Council
and the SEC directed all banking organizations under their supervision
to ensure that the pandemic plans the financial institutions have in
place are adequate to maintain critical operations during a severe
outbreak. SEC issued similar requirements to the major securities
industry market organizations.
Further Actions Are Needed to Address the Capacity to Respond to and
Recover from an Influenza Pandemic:
Improving the nation's response capability to catastrophic disasters,
such as an influenza pandemic, is essential. Following a mass casualty
event, health care systems would need the ability to adequately care
for a large number of patients or patients with unusual or highly
specialized medical needs. The ability of local or regional health care
systems to deliver services could be compromised, at least in the short
term, because the volume of patients would far exceed the available
hospital beds, medical personnel, pharmaceuticals, equipment, and
supplies. Further, in natural and man-made disasters, assistance from
other states may be used to increase capacity, but in a pandemic,
states would likely be reluctant to provide assistance to each other
due to scarce resources and fears of infection.
Over the last few years, Congress has provided over $13 billion in
supplemental funding for pandemic preparedness. The $5.62 billion that
Congress provided in supplemental funding to HHS in 2006 was for, among
other things, (1) monitoring disease spread to support rapid response,
(2) developing vaccines and vaccine production capacity, (3)
stockpiling antivirals and other countermeasures, (4) upgrading state
and local capacity, and (5) upgrading laboratories and research at
CDC.[Footnote 29] The majority of this supplemental funding--about 77
percent--was allocated for developing antivirals and vaccines for a
pandemic, and purchasing medical supplies. Also, a portion of the
funding that went to states and localities for preparedness activities--
$170 million--was allocated for state antiviral purchases for their
state stockpiles. In June 2009, Congress approved and the President
signed a supplemental appropriations act that included $7.7 billion for
pandemic flu preparedness, including the development and purchase of
vaccine, antivirals, necessary medical supplies, diagnostics, and other
surveillance tools and to assist international efforts and respond to
international needs relating to the 2009-H1N1 influenza outbreak.
[Footnote 30] This amount included $1.85 billion to be available
immediately and $5.8 billion to be available subsequently in the
amounts designated by the President as emergency funding requirements.
On July 10, 2009, HHS announced its plans to use the $350 million
designated for upgrading state and local capacity for additional grants
to states and territories to prepare for the H1N1 pandemic and seasonal
influenza. State public health departments will receive $260 million,
and hospitals will receive $90 million of these grant funds.
An outbreak will require additional capacity in many areas, including
the procurement of additional patient treatment space and the
acquisition and distribution of medical and other critical supplies,
such as antivirals and vaccines for an influenza pandemic.[Footnote 31]
In a severe pandemic, the demand would exceed the available hospital
bed capacity, which would be further challenged by the existing
shortages of health care providers and their potential high rates of
absenteeism. In addition, the availability of antivirals and vaccines
could be inadequate to meet demand due to limited production,
distribution, and administration capacity.
The federal government has provided some guidance in addition to
funding to help states plan for additional capacity. For example, the
federal government provided guidance for states to use when preparing
for medical surge and on prioritizing target groups for an influenza
pandemic vaccine. Some state officials reported, however, that they had
not begun work on altered standards of care guidelines, that is, for
providing care while allocating scarce equipment, supplies, and
personnel in a way that saves the largest number of lives in mass
casualty event, or had not completed drafting guidelines, because of
the difficulty of addressing the medical, ethical, and legal issues
involved. We recommended that HHS serve as a clearinghouse for sharing
among the states altered standards of care guidelines developed by
individual states or medical experts. HHS did not comment on the
recommendation, and it has not indicated if it plans to implement
it.[Footnote 32] Further, in our June 2008 report on state and local
planning and exercising efforts for an influenza pandemic, we found
that state and local officials reported that they wanted federal
influenza pandemic guidance on facilitating medical surge, which was
also one of the areas that the HHS-led assessment rated as having "many
major gaps" nationally among states' influenza pandemic plans.[Footnote
33]
Federal Agencies Have Provided Considerable Guidance and Pandemic-
Related Information, but Could Augment Their Efforts:
The National Pandemic Implementation Plan emphasizes that government
and public health officials must communicate clearly and continuously
with the public throughout a pandemic. Accordingly, HHS, DHS, and other
federal agencies have shared pandemic-related information in a number
of ways, such as through Web sites, guidance, and state summits and
meetings, and are using established networks, including coordinating
councils for critical infrastructure protection, to share information
about pandemic preparedness, response, and recovery. Federal agencies
have established an influenza pandemic Web site [hyperlink,
http://www.pandemicflu.gov] and disseminated pandemic preparedness
checklists for workplaces, individuals and families, schools, health
care, community organizations, and state and local governments.
However, state and local officials from all of the states and
localities we interviewed for our June 2008 report on state and local
pandemic planning and exercising, wanted additional influenza pandemic
guidance from the federal government on specific topics, on how to
implement community interventions such as closing schools, fatality
management, and facilitating medical surge. Although the federal
government had issued some guidance at the time of our review, it may
not have reached state and local officials or may not have addressed
the particular concerns or circumstances of the state and local
officials we interviewed. More recently, CDC has issued additional
guidance on a number of topics related to responding to the H1N1
outbreak. CDC issued interim guidance on school closures which
originally recommended that schools with confirmed H1N1 influenza
close. Once it became more clear that the disease severity of H1N1 was
similar to that of seasonal influenza and that the virus had already
spread within communities, CDC determined that school closure would be
less effective as a measure of control and issued updated guidance
recommending that schools not close for suspected or confirmed cases of
influenza.[Footnote 34] However, the change in guidance caused
confusion, underscoring the importance of clear and continuous
communication with the public throughout a pandemic. In addition,
private sector officials have told us that they would like
clarification about the respective roles and responsibilities of the
federal and state governments during an influenza pandemic emergency,
such as in state border closures and influenza pandemic vaccine
distribution.
Performance Monitoring and Accountability for Pandemic Preparedness
Needs Strengthening:
While the National Pandemic Strategy and Implementation Plan identify
overarching goals and objectives for pandemic planning, the documents
are not altogether clear on the roles, responsibilities, and
requirements to carry out the plan. Some of the action items in the
National Pandemic Implementation Plan, particularly those that are to
be completed by state, local, and tribal governments or the private
sector, do not identify an entity responsible for carrying out the
action. Most of the implementation plan's performance measures consist
of actions to be completed, such as disseminating guidance, but the
measures are not always clearly linked with intended results.
For example, one action item asked that all HHS-, Department of
Defense- and Veterans Administration-funded hospitals and health
facilities develop, test, and be prepared to implement infection
control campaigns for pandemic influenza within 3 months. However, the
associated performance measure is not clearly linked to the intended
result. This performance measure states that infection control guidance
should be developed and disseminated on [hyperlink,
http://www.pandemicflu.gov] and other channels.[Footnote 35] This
action would not directly result in developing, testing, and preparing
to implement infection control campaigns. This lack of clear linkage
makes it difficult to ascertain whether progress has in fact been made
toward achieving the national goals and objectives described in the
National Pandemic Strategy and Implementation Plan. Without a clear
linkage to anticipated results, these measures of activities do not
give an indication of whether the purpose of the activity is achieved.
In addition, as discussed earlier, the National Pandemic Implementation
Plan does not establish priorities among its 324 action items, which
becomes especially important as agencies and other parties strive to
effectively manage scarce resources and ensure that the most important
steps are accomplished. Moreover, the National Pandemic Strategy and
its Implementation Plan do not provide information on the financial
resources needed to implement them, which is one of six characteristics
of an effective national strategy that we have identified. As a result,
the documents do not provide a picture of priorities or how adjustments
might be made in view of resource constraints.
As discussed earlier, the National Pandemic Implementation Plan also
required federal agencies to develop operational pandemic plans to
describe, among other requirements, how each agency will protect its
workforce and maintain essential operations and services in the event
of a pandemic. [Footnote 36] We recently reported, however, that there
is no mechanism in place to monitor and report on agencies' progress in
developing these plans. Under the Implementation Plan, DHS was charged
with this responsibility, but instead the HSC simply requested that
agencies certify to the council that they were addressing in their
plans the applicable elements of a pandemic checklist. The
certification process did not provide for monitoring and reporting on
agencies' abilities to continue operations in the event of a pandemic
while protecting their employees. Moreover, even as envisioned under
the Implementation Plan, the report was to be directed to the Executive
Office of the President with no provision for the report to be made
available to Congress.
As noted earlier, given agencies' uneven progress in developing their
pandemic plans, monitoring and reporting would enhance agencies'
accountability to protect their employees during a pandemic. We
therefore recommended that the HSC request that the Secretary of
Homeland Security monitor and report to the Executive Office of the
President on the readiness of agencies to continue their operations
while protecting their employees in the event of a pandemic. We also
suggested that to help support its oversight responsibilities, Congress
may want to consider requiring DHS to report to it on agencies'
progress in developing and implementing their plans, including any key
challenges and gaps in the plans. The HSC noted that it will give
serious consideration to the report findings and recommendations, and
DHS said the report findings and recommendations will contribute to its
efforts to ensure that government entities are well prepared for what
may come next.
Concluding Observations:
The current H1N1 influenza pandemic should serve as a powerful reminder
that the threat of a more virulent pandemic, which seemed to fade from
public awareness in recent years, never really disappeared. While
federal agencies have taken action on many of our recommendations,
about half the recommendations that we have made over the past 3 years
are still not fully implemented. It is essential, given the change in
administration and the associated transition of senior federal
officials, that the shared leadership roles that have been established
between HHS and DHS, along with other responsible federal officials,
are tested in rigorous tests and exercises. Likewise, DHS should
continue to work with other federal agencies and private sector members
of the critical infrastructure coordinating councils to help address
the challenges of coordination and clarify roles and responsibilities
of federal and state governments. DHS and HHS should also, in
coordination with other federal agencies, continue to work with states
and local governments to help them address identified gaps in their
pandemic planning. Moreover, the 3-year period covered by the National
Pandemic Implementation Plan is now over and it will be important for
HSC to establish a process for updating the National Pandemic
Implementation Plan so that the updated plan can address the gaps we
have identified, as well as lessons learned from the current H1N1
outbreak. Finally, greater monitoring and reporting of agencies'
progress in plans to protect their workers during a pandemic are needed
to insure the readiness of agencies to continue operations while
protecting their employees in the event of a pandemic.
Pandemic influenzas, as I noted earlier, differ from other types of
disasters in that they are not necessarily discrete events. While the
current H1N1 pandemic seems to be relatively mild, the virus could
become more virulent this fall or winter. Given this risk, the
administration and federal agencies should use this opportunity to turn
their attention to filling in some of the planning and preparedness
gaps our work has pointed out, while time is still on our side.
Chairman Thompson and Members of the Committee, this concludes my
prepared statement. I would be happy to respond to any questions you
may have.
Contacts and Staff Acknowledgements:
For further information regarding this statement, please contact
Bernice Steinhardt, Director, Strategic Issues, at (202) 512-6543 or
steinhardtb@gao.gov. Contact points for our Offices of Congressional
Relations and Public Affairs may be found on the last page of this
statement. Individuals making key contributions to this testimony
include Sarah Veale, (Assistant Director), Maya Chakko, David Fox, Bill
Doherty, Ellen Grady, Karin Fangman, and members of GAO's Pandemic
Working Group.
[End of section]
Attachment I: Open Recommendations from GAO's Work on an Influenza
Pandemic:
Title and GAO product number: Influenza Pandemic: Increased Agency
Accountability Could Help Protect Federal Employees Serving the Public
in the Event of a Pandemic, [hyperlink,
http://www.gao.gov/products/GAO-09-404], June 12, 2009;
Summary of open recommendations: The Homeland Security Council should
request that the Secretary of Homeland Security monitor and report to
the Executive Office of the President on the readiness of agencies to
continue their operations while protecting their employees in the event
of an influenza pandemic;
Status: The Homeland Security Council commented that the council will
give serious consideration to the report's findings and
recommendations. DHS commented that the report's findings and
recommendations will contribute to its efforts to ensure that
government entities are well prepared for what may come next.
Title and GAO product number: Influenza Pandemic: HHS Needs to Continue
Its Actions and Finalize Guidance for Pharmaceutical Interventions,
[hyperlink, http://www.gao.gov/products/GAO-08-671], September 30,
2008;
Summary of open recommendations: The Secretary of Health and Human
Services should expeditiously finalize guidance to assist state and
local jurisdictions to determine how to effectively use limited
supplies of antivirals and pre-pandemic vaccine in a pandemic,
including prioritizing target groups for pre-pandemic vaccine;
Status: In December 2008, HHS released final guidance on antiviral drug
use during an influenza pandemic. HHS officials informed us that they
are drafting the guidance on pre-pandemic influenza vaccination.
Title and GAO product number: Influenza Pandemic: Federal Agencies
Should Continue to Assist States to Address Gaps in Pandemic Planning,
[hyperlink, http://www.gao.gov/products/GAO-08-539], June 19, 2008;
Summary of open recommendations: The Secretaries of Health and Human
Services and Homeland Security should, in coordination with other
federal agencies, convene additional meetings of the states in the five
federal influenza pandemic regions to help them address identified gaps
in their planning;
Status: HHS and DHS officials indicated that while no additional
meetings are planned at this time, states will have to continuously
update their pandemic plans and submit them for review.
Title and GAO product number: Influenza Pandemic: Opportunities Exist
to Address Critical Infrastructure Protection Challenges That Require
Federal and Private Sector Coordination, [hyperlink,
http://www.gao.gov/products/GAO-08-36], October 31, 2007;
Summary of open recommendations: The Secretary of Homeland Security
should work with sector-specific agencies and lead efforts to encourage
the government and private sector members of the councils to consider
and help address the challenges that will require coordination between
the federal and private sectors involved with critical infrastructure
and within the various sectors, in advance of, as well as during, a
pandemic;
Status: DHS officials informed us that the department is working on
initiatives, such as developing pandemic contingency plan guidance
tailored to each of the critical infrastructure sectors, and holding a
series of webinars with a number of the sectors.
Title and GAO product number: Influenza Pandemic: Further Efforts Are
Needed to Ensure Clearer Federal Leadership Roles and an Effective
National Strategy, [hyperlink, http://www.gao.gov/products/GAO-07-781],
August 14, 2007;
Summary of open recommendations: (1) The Secretaries of Homeland
Security and Health and Human Services should work together to develop
and conduct rigorous testing, training, and exercises for an influenza
pandemic to ensure that the federal leadership roles are clearly
defined and understood and that leaders are able to effectively execute
shared responsibilities to address emerging challenges. Once the
leadership roles have been clarified through testing, training, and
exercising, the Secretaries of Homeland Security and Health and Human
Services should ensure that these roles are clearly understood by
state, local, and tribal governments; the private and nonprofit
sectors; and the international community;
Status: (1) HHS and DHS officials stated that several influenza
pandemic exercises had been conducted since November 2007 that involved
both agencies and other federal officials, but it is unclear whether
these exercises rigorously tested federal leadership roles in a
pandemic.
Title and GAO product number: Influenza Pandemic: Opportunities Exist
to Clarify Federal Leadership Roles and Improve Pandemic Planning,
[hyperlink, http://www.gao.gov/products/GAO-07-1257T], September 26,
2007;
Summary of open recommendations: (2) The Homeland Security Council
should establish a specific process and time frame for updating the
National Pandemic Implementation Plan. The process should involve key
nonfederal stakeholders and incorporate lessons learned from exercises
and other sources. The National Pandemic Implementation Plan should
also be improved by including the following information in the next
update: (a) resources and investments needed to complete the action
items and where they should be targeted, (b) a process and schedule for
monitoring and publicly reporting on progress made on completing the
action items, (c) clearer linkages with other strategies and plans, and
(d) clearer descriptions of relationships or priorities among action
items and greater use of outcome-focused performance measures;
Status: (2) HSC did not comment on the recommendation and has not
indicated if it plans to implement it.
Title and GAO product number: Avian Influenza: USDA Has Taken Important
Steps to Prepare for Outbreaks, but Better Planning Could Improve
Response, [hyperlink, http://www.gao.gov/products/GAO-07-652], June 11,
2007;
Summary of open recommendations: (1) The Secretaries of Agriculture and
Homeland Security should develop a memorandum of understanding that
describes how USDA and DHS will work together in the event of a
declared presidential emergency or major disaster, or an Incident of
National Significance, and test the effectiveness of this coordination
during exercises;
Status: (1) Both USDA and DHS officials told us that they have taken
preliminary steps to develop additional clarity and better define their
coordination roles. For example, the two agencies meet on a regular
basis to discuss such coordination.
Summary of open recommendations: (2) The Secretary of Agriculture
should, in consultation with other federal agencies, states, and the
poultry industry identify the capabilities necessary to respond to a
probable scenario or scenarios for an outbreak of highly pathogenic
avian influenza. The Secretary of Agriculture should also use this
information to develop a response plan that identifies the critical
tasks for responding to the selected outbreak scenario and, for each
task, identifies the responsible entities, the location of resources
needed, time frames, and completion status. Finally, the Secretary of
Agriculture should test these capabilities in ongoing exercises to
identify gaps and ways to overcome those gaps;
Status: (2) USDA officials told us that it has created a draft
preparedness and response plan that identifies federal, state, and
local actions, timelines, and responsibilities for responding to highly
pathogenic avian influenza, but the plan has not been issued yet.
Summary of open recommendations: (3) The Secretary of Agriculture
should develop standard criteria for the components of state response
plans for highly pathogenic avian influenza, enabling states to develop
more complete plans and enabling USDA officials to more effectively
review them;
Status: (3) USDA told us that it has drafted large volumes of guidance
documents that are available on a secure Web site. However, the
guidance is still under review and it is not clear what standard
criteria from these documents USDA officials and states should apply
when developing and reviewing plans;
Summary of open recommendations: (4) The Secretary of Agriculture
should focus additional work with states on how to overcome potential
problems associated with unresolved issues, such as the difficulty in
locating backyard birds and disposing of carcasses and materials;
Status: (4) USDA officials have told us that the agency has developed
online tools to help states make effective decisions about carcass
disposal. In addition, USDA has created a secure Internet site that
contains draft guidance for disease response, including highly
pathogenic avian influenza, and it includes a discussion about many of
the unresolved issues;
Summary of open recommendations: (5) The Secretary of Agriculture
should determine the amount of antiviral medication USDA would need in
order to protect animal health responders, given various highly
pathogenic avian influenza scenarios. The Secretary of Agriculture
should also determine how to obtain and provide supplies within 24
hours of an outbreak;
Status: (5) USDA officials told us that the National Veterinary
Stockpile contains enough antiviral medication to protect 3,000 animal
health responders for 40 days. However, USDA has yet to determine the
number of individuals who would need medicine based on a calculation of
those exposed to the virus under a specific scenario. Further, USDA
officials told us that a contract for additional medication for the
stockpile has not yet been secured, which would better ensure that
medications are available in the event of an outbreak of highly
pathogenic avian influenza.
Source: GAO.
[End of table]
[End of section]
Attachment II: Related GAO Products:
Influenza Pandemic: Greater Agency Accountability Needed to Protect
Federal Workers in the Event of a Pandemic. [hyperlink,
http://www.gao.gov/products/GAO-09-783T]. Washington, D.C.: June 16,
2009.
Influenza Pandemic: Increased Agency Accountability Could Help Protect
Federal Employees Serving the Public in the Event of a Pandemic.
[hyperlink, http://www.gao.gov/products/GAO-09-404]. Washington, D.C.:
June 12, 2009.
Influenza Pandemic: Continued Focus on the Nation's Planning and
Preparedness Efforts Remains Essential. [hyperlink,
http://www.gao.gov/products/GAO-09-760T]. Washington, D.C.: June 3,
2009.
Influenza Pandemic: Sustaining Focus on the Nation's Planning and
Preparedness Efforts. [hyperlink,
http://www.gao.gov/products/GAO-09-334]. Washington, D.C.: February 26,
2009.
Influenza Pandemic: HHS Needs to Continue Its Actions and Finalize
Guidance for Pharmaceutical Interventions. [hyperlink,
http://www.gao.gov/products/GAO-08-671]. Washington, D.C.: September
30, 2008.
Influenza Pandemic: Federal Agencies Should Continue to Assist States
to Address Gaps in Pandemic Planning. [hyperlink,
http://www.gao.gov/products/GAO-08-539]. Washington, D.C.: June 19,
2008.
Emergency Preparedness: States Are Planning for Medical Surge, but
Could Benefit from Shared Guidance for Allocating Scarce Medical
Resources. [hyperlink, http://www.gao.gov/products/GAO-08-668].
Washington, D.C.: June 13, 2008.
Influenza Pandemic: Efforts Under Way to Address Constraints on Using
Antivirals and Vaccines to Forestall a Pandemic. [hyperlink,
http://www.gao.gov/products/GAO-08-92]. Washington, D.C.: December 21,
2007.
Influenza Pandemic: Opportunities Exist to Address Critical
Infrastructure Protection Challenges That Require Federal and Private
Sector Coordination. [hyperlink,
http://www.gao.gov/products/GAO-08-36]. Washington, D.C.: October 31,
2007.
Influenza Pandemic: Federal Executive Boards' Ability to Contribute to
Pandemic Preparedness. [hyperlink,
http://www.gao.gov/products/GAO-07-1259T]. Washington, D.C.: September
28, 2007.
Influenza Pandemic: Opportunities Exist to Clarify Federal Leadership
Roles and Improve Pandemic Planning. [hyperlink,
http://www.gao.gov/products/GAO-07-1257T]. Washington, D.C.: September
26, 2007.
Influenza Pandemic: Further Efforts Are Needed to Ensure Clearer
Federal Leadership Roles and an Effective National Strategy.
[hyperlink, http://www.gao.gov/products/GAO-07-781]. Washington, D.C.:
August 14, 2007.
Emergency Management Assistance Compact: Enhancing EMAC's Collaborative
and Administrative Capacity Should Improve National Disaster Response.
[hyperlink, http://www.gao.gov/products/GAO-07-854]. Washington, D.C.:
June 29, 2007.
Influenza Pandemic: DOD Combatant Commands' Preparedness Efforts Could
Benefit from More Clearly Defined Roles, Resources, and Risk
Mitigation. [hyperlink, http://www.gao.gov/products/GAO-07-696].
Washington, D.C.: June 20, 2007.
Influenza Pandemic: Efforts to Forestall Onset Are Under Way;
Identifying Countries at Greatest Risk Entails Challenges. [hyperlink,
http://www.gao.gov/products/GAO-07-604]. Washington, D.C.: June 20,
2007.
Avian Influenza: USDA Has Taken Important Steps to Prepare for
Outbreaks, but Better Planning Could Improve Response. [hyperlink,
http://www.gao.gov/products/GAO-07-652]. Washington, D.C.: June 11,
2007.
The Federal Workforce: Additional Steps Needed to Take Advantage of
Federal Executive Boards' Ability to Contribute to Emergency
Operations. [hyperlink, http://www.gao.gov/products/GAO-07-515].
Washington, D.C.: May 4, 2007.
Financial Market Preparedness: Significant Progress Has Been Made, but
Pandemic Planning and Other Challenges Remain. [hyperlink,
http://www.gao.gov/products/GAO-07-399]. Washington, D.C.: March 29,
2007.
Influenza Pandemic: DOD Has Taken Important Actions to Prepare, but
Accountability, Funding, and Communications Need to be Clearer and
Focused Departmentwide. [hyperlink,
http://www.gao.gov/products/GAO-06-1042]. Washington, D.C.: September
21, 2006.
Catastrophic Disasters: Enhanced Leadership, Capabilities, and
Accountability Controls Will Improve the Effectiveness of the Nation's
Preparedness, Response, and Recovery System. [hyperlink,
http://www.gao.gov/products/GAO-06-618]. Washington, D.C.: September 6,
2006.
[End of section]
Footnotes:
[1] GAO's 2009 Congressional and Presidential Transition Web site:
[hyperlink, http://www.gao.gov/transition_2009].
[2] We also have two pandemic-related reviews underway on the following
topics: (1) the status of implementing the National Strategy for
Pandemic Influenza Implementation Plan (National Pandemic
Implementation Plan); and (2) the effect of a pandemic on the
telecommunications capacity needed to sustain critical financial market
activities.
[3] GAO, Influenza Pandemic: Sustaining Focus on the Nation's Planning
and Preparedness Efforts, [hyperlink,
http://www.gao.gov/products/GAO-09-334] (Washington, D.C.: Feb. 26,
2009).
[4] GAO, Influenza Pandemic: Increased Agency Accountability Could Help
Protect Federal Employees Serving the Public in the Event of a
Pandemic, [hyperlink, http://www.gao.gov/products/GAO-09-404]
(Washington, D.C.: June 12, 2009).
[5] On June 11, 2009, the World Health Organization (WHO) raised its
influenza pandemic alert level from phase 5 to the highest phase, phase
6, signaling the widespread human infection associated with a pandemic
for the H1N1 virus.
[6] GAO, Influenza Pandemic: Further Efforts Are Needed to Ensure
Clearer Federal Leadership Roles and an Effective National Strategy,
[hyperlink, http://www.gao.gov/products/GAO-07-781] (Washington, D.C.:
Aug. 14, 2007).
[7] On May 26, 2009, the President announced the full integration of
White House staff supporting national security and homeland security.
The Homeland Security Council will be maintained as the principal venue
for interagency deliberations on issues that affect the security of the
homeland, such as influenza pandemic.
[8] Pub. L. No. 109-295, Title VI.
[9] GAO, Homeland Security: Observations on DHS and FEMA Efforts to
Prepare for and Respond to Major and Catastrophic Disasters and Address
Related Recommendations and Legislation, [hyperlink,
http://www.gao.gov/products/GAO-07-1142T] (Washington, D.C.: July 31,
2007).
[10] [hyperlink, http://www.gao.gov/products/GAO-07-781].
[11] GAO, Influenza Pandemic: Opportunities Exist to Address Critical
Infrastructure Protection Challenges That Require Federal and Private
Sector Coordination, [hyperlink, http://www.gao.gov/products/GAO-08-36]
(Washington, D.C.: Oct. 31, 2007).
[12] The 18 critical infrastructure and key resource sectors are: food
and agriculture; banking and finance; chemical; commercial facilities;
commercial nuclear reactors, materials, and water; dams; defense
industrial base; drinking water and water treatment systems; emergency
services; energy; governmental facilities; information technology;
national monuments and icons; postal and shipping; public health and
healthcare; telecommunications; transportation systems; and critical
manufacturing. Critical infrastructure are systems and assets, whether
physical or virtual, so vital to the United States that their
incapacity or destruction would have a debilitating effect on national
security, national economic security, and national public health or
safety, or any combination of those matters. Key resources are publicly
or privately controlled resources essential to minimal operations of
the economy or government, including individual targets whose
destruction would not endanger vital systems but could create a local
disaster or profoundly damage the nation's morale or confidence.
[13] [hyperlink, http://www.gao.gov/products/GAO-08-36].
[14] GAO, The Federal Workforce: Additional Steps Needed to Take
Advantage of Federal Executive Boards' Ability to Contribute to
Emergency Operations, [hyperlink,
http://www.gao.gov/products/GAO-07-515] (Washington, D.C.: May 4,
2007).
[15] Issued in January 2008 by DHS and effective in March 2008, the NRF
is a guide to how the nation conducts all-hazards incident response and
replaces the National Response Plan. It focuses on how the federal
government is organized to support communities and states in
catastrophic incidents. The NRF builds upon the National Incident
Management System, which provides a national template for managing
incidents.
[16] GAO, Influenza Pandemic: Efforts Under Way to Address Constraints
on Using Antivirals and Vaccines to Forestall a Pandemic, [hyperlink,
http://www.gao.gov/products/GAO-08-92] (Washington, D.C.: Dec. 21,
2007).
[17] The six characteristics of an effective national strategy include:
(1) purpose, scope, and methodology; (2) problem definition and risk
assessment; (3) goals, subordinate objectives, activities, and
performance measures; (4) resources, investments, and risk management;
(5) organizational roles, responsibilities, and coordination; and (6)
integration and implementation. GAO, Combating Terrorism: Evaluation of
Selected Characteristics in National Strategies Related to Terrorism,
[hyperlink, http://www.gao.gov/products/GAO-04-408T] (Washington, D.C.:
Feb. 3, 2004).
[18] [hyperlink, http://www.gao.gov/products/GAO-09-404].
[19] The survey was conducted from May through July 2008, and the
results were confirmed or updated in early 2009.
[20] Social distancing is a technique used to minimize close contact
among persons in public places, such as work sites and public areas.
[21] GAO, Influenza Pandemic: Federal Agencies Should Continue to
Assist States to Address Gaps in Pandemic Planning, [hyperlink,
http://www.gao.gov/products/GAO-08-539], (Washington, DC: June 19,
2008).
[22] We conducted site visits to the five most populous states
including California, Florida, Illinois, New York, and Texas for a
number of reasons, including that these states constituted over one-
third of the U.S. population, received over one-third of the total
funding from HHS and DHS that could be used for planning and exercising
efforts, and were likely entry points for individuals coming from
another country given that the states either bordered Mexico or Canada
or contained major ports, or both. Within each state, we also
interviewed officials at 10 localities, which consisted of 5 urban
areas and 5 rural counties.
[23] DHS and HHS and other agencies, Assessment of States' Operating
Plans to Combat Pandemic Influenza: Report to Homeland Security Council
(Washington, D.C.: January 2009).
[24] [hyperlink, http://www.gao.gov/products/GAO-08-539].
[25] [hyperlink, http://www.gao.gov/products/GAO-09-334].
[26] [hyperlink, http://www.gao.gov/products/GAO-08-539].
[27] National Governors Association Center for Best Practices, Issue
Brief: Pandemic Preparedness in the States--An Assessment of Progress
and Opportunity (September 2008).
[28] GAO, Financial Market Preparedness: Significant Progress Has Been
Made, but Pandemic Planning and Other Challenges Remain, [hyperlink,
http://www.gao.gov/products/GAO-07-399] (Washington, D.C.: Mar. 29,
2007).
[29] Pub. L. No. 109-148 and Pub. L. No. 109-234.
[30] Pub. L. No. 111-32.
[31] Antivirals can prevent or reduce the severity of a viral
infection, such as influenza. Vaccines are used to stimulate the
production of an immune system response to protect the body from
disease.
[32] GAO, Emergency Preparedness: States Are Planning for Medical
Surge, but Could Benefit from Shared Guidance for Allocating Scarce
Medical Resources, [hyperlink, http://www.gao.gov/products/GAO-08-668],
(Washington, DC: June 13, 2008).
[33] [hyperlink, http://www.gao.gov/products/GAO-08-539].
[34] Centers for Disease Control and Prevention,Update on School (K -
12) and Child Care Programs: Interim CDC Guidance in Response to Human
Infections with the Novel Influenza A (H1N1) Virus (Updated May 22,
2009).
[35] Homeland Security Council, National Strategy for Pandemic
Influenza Implementation Plan (Washington,D.C.: May 2006).
[36] [hyperlink, http://www.gao.gov/products/GAO-09-404].
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